[Measurement of anterior-posterior diameter of IVC by ultrasonography: a non invasive method for estimation of central venous pressure]

The assessment of intravascular volume in severely traumatized patients or patients admitted in ICU is very essential. At present the accurate method for estimating the intravascular volume requirement is by measuring the CVP which is an invasive method. The measurement of IVC diameter by ultrasound has been suggested as an easily available and simple method for measuring the intravascular volume status. The purpose of this study was to compare the results of IVC diameter measurement by ultrasonography and CVP measurement for calculating the intravascular volume in ICU admitted patients. This was a descriptive and prospective stud]' including 50 patients admitted in ICU with a central Venous catheter placed for any reason whatsoever and no signs of increased right atrial pressure. CVP was measured in supine position by CVP manometer. The anterior- posterior IVC diameter was assessed by ultrasonography during inspiration and expiration. Data analysis was performed by SPSS and evaluated statistically with Pearsons regression and linear correlation test. The mean CVP at inspiration and during expiration was 11.35 +/- 5.53, 12.20 +/- 5.65 cm H2O, respectively. The mean of inspiratory and expiratory IVC diameter was 7.71 +/- 3.5, 11.37 +/- 3.28 mm, respectively. There was significant correlation between CVP and IVC diameter both during inspiration [r= 0.64, p-value= 0.001] and expiration [r=0.495, p-value=0.001] The result of this study suggests that IVC diameter measurement by ultrasound can be used as a reliable and non- invasive method for estimating the intravascular volume

[Effect of serum zinc levels on humoral immune response to hepatitis b vaccination in patients on dialysis]

Zinc deficiency causes abnormalities in immune response. In chronic hemodialysis [I-ID] and continuous ambulatory peritoneal dialysis [CAPD] patients, impaired immune responses to vaccination have been reported. Therefore, we performed a study to determine the correlation between serum zinc levels and immune response to hepatitis B vaccination in patients on dialysis. A cross-sectional study including 95 CRF patients on dialysis [70 HD and 25 CAPD], [63 male and 32 female] with three dose regimens of vaccination against HBV was performed. Four months after vaccination, there were 34 [36%] patients with sufficient HBs Antibody response [HBs Ab >/= 10 MU/mL] and 61[64%] patients with insufficient HBs antibody response[HBs Ab< 10mU/mL]. The mean serum zinc level was 23.35 +/- 3.87 micmol/L [13.20-33 micmol/L]. The mean serum zinc concentration was significantly higher in patients with sufficient HBs antibody level than patients with insufficient HBs antibody levels [24.94 +/- 4.17 versus 22.15 +/- 3.46, P= 0.005]. In logistic regression analysis, independent variables that correlated with sufficient HBs Ab level >/= 10 MU/mL included higher mean serum zinc level [OR=1.44 [1.02-2.02], P=0.006] and female gender [OR=1.8 [1.01-4.01], P=0.048]. Factors found to be insignificant included type of dialysis, age, diabetes mellitus as a cause of ESRD, serum creatinine and albumin levels. We conclude that failure to respond to HBV vaccination is significantly related to a low levels of serum zinc. However, clinical trial studies should be performed in order to confirm this finding

[Determining the diagnostic value of alkaline phosphatase in comparison with parathyroid hormone [PTH] of renal osteodystrophy for treatment with calcitriol in hemodialysis patients]

Serum parathyroid hormone [PTH] is one of the most important tests for treatment of hemodialysis patients with calcitriol. This drug should be started when the PTH >/= 200 pg/ml. However, the appropriate level of serum alkaline phosphates [ALP] for starting calcitriol is unclear. The aim of this study was to determine serum ALP as cutoff point for treatment of secondary hyperparathyroidism with calcitriol. This study was a cross sectional. The serum level of PTH and ALP were measured in 75 chronic hemodialysis patients. The correlation between PTH and ALP in diagnosis for treatment with calcitriol was significant [Kappa test P-Value=0.000]. In determination of diagnostic value of ALP [at level 300IU/L] for treatment with calcitriol, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 88.9%, 93.9%, 66.7%, 98.4% and 93.3%, respectively. The cutoff point of ALP for treatment with calcitriol was 300IU/L [normal 100-290IU/L]. These findings suggest that serum ALP is a good test for treatment of secondary hyperparathyroidism. The results also indicate that calcitriol administration should not be started with ALP<300 IU/L